Before menopause, "Sylvia" was plagued by severe PMS (now known as PMDD - Pre Menstrual Dysphoric Disorder). She had migraines each month in tandem with her period and her work suffered because she lost focus regularly. After menopause her brain fog worsened. Little did she know that her undiagnosed ADHD was part of the hormonal snafu.
Estrogen, specifically estradiol, the predominant estrogen for women during childbearing years, has come under scrutiny as a potent influence on cognition, memory and plasticity of the brain. Research released from the University of Massachusetts at Amherst and UCLA shows that estradiol can act like a neurotransmitter as well as a hormone in the bloodstream. The UMass/UCLA study revealed that estradiol is actually created within the neurons of the pre-frontal cortex and facilitates the speedy transmission of neurologic impulses. Estradiol also increases the concentration of neurotransmitters such as serotonin, dopamine and norepinephrine. In other words, estradiol helps the brain work better and faster.
ADHD, on the other hand, is the result of underachieving neurotransmitters specifically dopamine and norepinephrine. When estradiol is at full strength in a woman's body, as it is at mid-cycle, the non-ADHD brain chugs along well. At an identical point in time, a woman's ADHD brain struggles to maintain focus, set priorities and follow through on tasks. When estradiol levels drop as they do just before menstrual bleeding begins, non-ADHD brains may temporarily stray from their previous straight and narrow pathways. The ADHD brain, already operating from a deficit of neurotransmitter connection, falls even more deeply into the abyss of memory loss and lack of concentration.
The situation gets worse at menopause when estrogen and progesterone do a wild dance of irregular abundance followed by scarcity. Many women experience mood swings, hot flushes and brain fog. ADHD women suffer even more severe mental impairment without their brain-friendly estradiol. This is often the time when previously undiagnosed women discover their latent ADHD. Menopause does indeed make ADHD symptoms worse because estradiol support for the brain virtually disappears. While not the underlying cause of ADHD, low estrogen levels play an important role in the severity of ADHD symptoms for women.
Some women opt for hormone therapy (HT) during the menopause transition. Others avoid HT due to potential medical risks. Generally speaking, over-the-counter supplements do not provide brain stimulation equal to estradiol. ADHD medications, however, often can stimulate neurotransmitter function and improve focus. Exercise, meditation and extra sleep are also recommended for ADHD women since they bolster brain alertness and memory.
LInda Roggli, PCC is the author of the award-winning book "Confessions of an ADDiva; midlife in the non-linear lane" and founder of the ADDiva Network for women with Attention Deficit Disorder (ADD or ADHD). She is a certified professional ADHD coach and moderates the largest Meetup support group for adults with ADHD in the US.